A retrospective, real-world study on serious infection risk in a multiracial rheumatoid arthritis population on advanced therapies

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Abstract
Objective: Advanced therapies have revolutionized the treatment landscape for rheumatoid arthritis. However, concerns exist regarding the risk of serious infections among patients receiving these therapies. This study aimed to determine the incidence of serious infections and identify predictive factors associated with serious infections in patients with rheumatoid arthritis receiving advanced therapies. Methods: This single-center retrospective cohort study reviewed patients with rheumatoid arthritis who attended the rheumatology clinic and/or ward at Universiti Malaya Medical Centre between January 2006 and December 2023. Patient demographic and clinical data, as well as data on treatment with advanced therapies, were collected. Logistic regression analyses were used to identify predictors of serious infections. Results: Of the 423 patients with rheumatoid arthritis identified, 87% were female. The mean age was 61.0 (SD: 13.8) years, and 80 (18.9%) received at least one advanced therapy. Sixteen (20%) patients developed serious infections, with a total of 23 serious infection episodes reported. The overall incidence rate of serious infections was 3.75 per 100 patient-years. Respiratory infections were the most common (52.2%), and tumor necrosis factor inhibitors had the highest incidence rate (4.25/100 patient-years) among the various classes of advanced therapies. Diabetes mellitus (odds ratio = 4.508, 95% confidence interval: 1.246–16.316; p = 0.022) and lung disease (odds ratio = 4.554, 95% confidence interval: 1.056–19.637; p = 0.042) were independent predictors of serious infections. Conclusion: Serious infections may develop among patients with rheumatoid arthritis receiving advanced therapy, with lung disease and diabetes mellitus identified as independent risk factors. This study may help improve clinicians’ awareness of the real-world risks associated with initiating advanced therapy. Future studies with a larger sample size are warranted to expand upon these findings.

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